The kids are not okay. In fact, the mental health crisis among American youths has become so acute during the COVID-19 pandemic that a coalition of pediatric health experts has declared it a national emergency.
In a joint statement released in October 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association — groups that represent more than 70,000 doctors nationwide — highlighted the serious toll that isolation, ongoing uncertainty, fear, and grief have taken on U.S. children and teens.
“The mental health of children and teens is at a critical tipping point,” says Lee Savio Beers, MD, president of the American Academy of Pediatrics and medical director for community health and advocacy at Children’s National Hospital in Washington, DC. “Child mental health issues were of great concern before the pandemic, and COVID-19 has only exacerbated them.”
When It Comes to Emotional Well-Being Among Kids, the Numbers Are Grim
Between March and October 2020, the percentage of emergency department visits for children with mental health emergencies rose by 24 percent for children 5 to 11 years old and by 31 percent for children and teens 12 to 17 years old, according to statistics from the Centers for Disease Control and Prevention (CDC) (which are highlighted in the joint statement).
Early in 2021, there was a more than 50 percent surge in emergency department visits for suspected suicide attempts among girls 12 to 17 years old, according to a separate CDC report (which is also cited in the joint statement). Suspected suicide attempts climbed in boys, too, but by a less dramatic 3.7 percent.
And as of June 2021, more than 140,000 children had lost a caregiver to COVID-19, according to a study published in October 2021 in Pediatrics. These losses hit communities of color particularly hard — these youth were up to 4.5 times more likely to lose a parent or grandparent caregiver to COVID-19 than white children and teens, according to the data.
“The inequities that result from structural racism increase the vulnerability to emergency situations, as evidenced by the disproportionate impacts of COVID-19 on communities of color,” Dr. Beers says.
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Adolescent Mental Health Was a Problem Before COVID-19
Even before the pandemic, nearly 1 in 5 children had a diagnosed mental illness, and only 20 percent of these patients received care from a mental health specialist, according to the CDC. Longstanding obstacles to treatment include stigma that may prevent parents from seeking help for their kids, long waiting lists for care, lack of insurance coverage, or a lack of access to providers who take insurance or charge affordable rates, the CDC notes.
The pandemic has highlighted and exacerbated many of these issues, says Rebecca Dudovitz, MD, an associate professor of pediatrics at the David Geffen School of Medicine at the University of California in Los Angeles, who was not involved in the new joint statement but researches how school environments influence children’s health.
“It has been a very stressful year and a half. And at the same time that stress was increasing, children lost a lot of the supports that help them cope with stress in healthy ways,” Dr. Dudovitz says. “That includes exercising, having routines, and connecting to people who can offer support.”
With schools closed, after-school activities and sports canceled, and typical family routines upended, young people lost access to many of the things that kept them feeling secure before the pandemic, as well as activities that helped them cope with stress and anxiety, Dudovitz says.
“Although we’ve known for a long time that our mental healthcare system lacked the capacity to serve everyone who needed help, now that so many more children are experiencing mental health problems, it’s just impossible to ignore,” Dudovitz says.
Schools reopening didn’t necessarily make things better, especially for teens, says Benjamin Shain, MD, PhD, who is head of child and adolescent psychiatry at NorthShore University HealthSystem in Chicago and has previously helped draft suicide screening guidelines for the American Academy of Pediatrics (though he was not involved in drafting this recent statement).
“In my own practice, there has been a surge of adolescents at risk of suicide just in the past month, which seems to be related to the start of school,” Dr. Shain says.
For some teens already struggling with their mental health, returning to crowded schools after a year in isolation compounded their stress, Shain says.
RELATED: Depression, Anxiety, Burnout on the Rise Among College Students Returning to Campus
What Pediatricians Want to See Happen
Several things might help improve access to mental health care and reduce the risk of acute psychiatric illness among children and teens, the coalition of pediatric health experts noted in the joint statement.
Telemedicine visits, which have become more common during the pandemic, might be one way to expand access to screening and treatment of mental health problems among young people, these experts argue.
RELATED: Expansion of Telemedicine Reveals Disparities in Who Has Access to Remote Care
School-based programs focused on suicide prevention and mental health screening and treatment could also help.
“There is good evidence that school-based screening and school mental health programs can help identify and treat mental health problems, but we need significant investments to expand them,” says Dudovitz. The joint statement calls for increased funding for school-based mental health care.
“Schools can also help children develop those healthy coping skills and there are great examples of evidence-based programs that help children build resilience and mindfulness skills,” Dudovitz adds.
Keeping kids in school and training teachers and staff to recognize and respond to trauma in ways that don’t make students feel worse may also help address the pediatric mental health crisis, says Angelica Robles, MD, a developmental-behavioral pediatrician at Novant Health in Charlotte, North Carolina, who treats children with a wide range of disabilities and researches how adverse experiences impact kids’ mental health. Dr. Robles, wasn’t involved in drafting the new statement.
Trauma-informed teaching, which recognizes the ways trauma can impact behavior and academic performance, can help, along with support for parents and families to reduce stressors at home.
California is one state that is ahead of the curve on these efforts, Robles says. The state has set an ambitious goal to halve children’s exposure to adverse childhood experiences and toxic stress within one generation. This means preventing a wide range of stressors such as physical, emotional, and sexual abuse; parental incarceration; mental illness; substance misuse; and domestic violence, according to a fact sheet on the initiative from the Office of the California Surgeon General.
“The national emergency is pushing these issues to the forefront in order to raise awareness and hopefully, build further mental health services and supports for children,” Robles says.
The joint statement also calls for:
- Integration of sustainable mental health care models in primary pediatric care, including models for payment
- Strengthened suicide prevention efforts in schools and community settings
- Addressing the workforce challenges in child mental health care
- Advancing policies that ensure compliance with and enforcement of mental health parity laws
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